| Determinants of first-shock success for atrial implantable cardioverter defibrillators. | |
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MedLine Citation:
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PMID: 12033351 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: The aim of this study was to identify determinants of first-shock success for defibrillation of spontaneous atrial fibrillation (AF) in ambulatory patients with an atrial implantable cardioverter defibrillator (ICD). The determinants of first-shock success in ambulatory patients with atrial ICDs are unknown. METHODS AND RESULTS: We used the generalized estimating equation method to analyze determinants of first-shock success in 50 consecutive atrial ICD recipients in whom DFT+ (weakest shock that defibrillates on two consecutive trials) was determined at implant and spontaneous AF was shocked with shock strength > or = 2 x DFT+. DFT+ was 6.2 +/- 3.1 J. Of 470 first shocks, 407 were successful (generalized estimating equation 85%, confidence interval 79% to 90%). Determinants of first-shock success were use of coronary sinus electrode (univariate P = 0.02; multivariate P < 0.001, relative risk 5.0), absence of a Class III antiarrhythmic drug (univariate P = 0.06; multivariate P < 0.001, relative risk 3.2), absence of early recurrence of atrial fibrillation (ERAF; univariate P = 0.06; multivariate P = 0.02, relative risk 2.9), and longer duration of AF prior to shock > or = 3 hours (univariate: P = 0.02; multivariate P = NS). Sinus rhythm >1 minute persisted after 93% of first shocks in patients without documented ERAF but after only 58% of shocks in patients with documented ERAF (P < 0.001). CONCLUSION: Reducing ERAF is critical to achieving a clinically acceptable rate of persistent sinus rhythm after first shocks. For first shocks > or = 2 x DFT +, success is not increased by programming stronger shocks. Early cardioversion does not increase first-shock success. |
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Authors:
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Charles D Swerdlow; David Schwartzman; Robert Hoyt; Steven J Bailin; Jodi L Koehler; Eduardo N Warman; |
Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 13 ISSN: 1045-3873 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2002 Apr |
Date Detail:
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Created Date: 2002-05-29 Completed Date: 2002-12-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 347-54 Citation Subset: IM |
Affiliation:
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Cedars-Sinai Medical Center, Los Angeles, California, USA. swerdlow@ucla.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Ambulatory Care
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methods Anti-Arrhythmia Agents / therapeutic use Atrial Fibrillation / therapy* Atrial Flutter / therapy* Combined Modality Therapy / methods Defibrillators, Implantable* Electric Countershock / methods* Female Follow-Up Studies Humans Male Middle Aged Multicenter Studies as Topic Recurrence Reproducibility of Results Risk Factors Sensitivity and Specificity Statistics as Topic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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